Need to know
Humans have consumed substances with consciousness-altering properties for millennia. Traditional societies used them in healing rituals, initiation ceremonies and to make contact with the gods and the dead, among other practices. Today they are known as psychedelics, and include the naturally occurring compounds psilocybin (found in ‘magic mushrooms’), DMT and mescaline; the hallucinogenic tea Ayahuasca, used by indigenous peoples in the Amazon basin; and the hallucinogenic shrub iboga, found in West Africa.
Synthetic hallucinogenic compounds, most famously LSD, emerged in the 20th century. The synthetic ‘party drugs’ MDMA (also known as ecstasy) and ketamine (used in medicine as an anaesthetic) are not technically classified as psychedelics, but they also produce consciousness-altering effects and are often considered under the same broad umbrella as the classic psychedelics.
In the industrialised West, psychedelic substances, especially LSD and magic mushrooms, burst on to the scene in the 1950s and ’60s with intense research interest in their therapeutic potential. However, an establishment backlash began in the late-1960s as the drugs became associated with the counterculture movement and opposition to the Vietnam War. Fermenting the eventual clampdown, the psychedelics-researcher-turned-evangelist Timothy Leary exhorted American youth to ‘turn on, tune in, drop out’. Tales spread of ‘bad trips’ and associated suicides, and the field of psychedelic research fell silent for decades.
We are now living through what’s been described as a ‘psychedelic renaissance’ that began in the 1990s. Research groups around the world, notably at Imperial College London and Johns Hopkins University in Baltimore, have been pumping out studies uncovering the neural basis of the drugs’ effects and exploring their apparent therapeutic benefits, especially when used as an adjunct to psychotherapy.
Research trials suggest that, when used as part of psychotherapy, the benefits of psychedelics include, but are not limited to, alleviating depression and anxiety (including for people who have not benefited from other forms of therapy or drug treatment), tackling longstanding symptoms of post-traumatic stress disorder, treating addiction, and calming existential distress in people with terminal illnesses.
Superior trial outcomes correlate with participants’ reports of having a mystical or transcendent experience during their psychedelic session. In fact, many people who take a psychedelic drug describe the experience as among the most personally meaningful of their lives. Many are changed by their trip, displaying greater open-mindedness, humility and feelings of connectedness with humanity and the wider world.
Although they can lead to subjectively similar experiences, different psychedelic drugs exert their effects in the brain via different mechanisms. For instance, psilocybin, mescaline and LSD act principally via the 5-HT2A receptor system (5-HT, also known as serotonin, is a neurotransmitter involved in mood and perception), whereas DMT acts on the 5-HT2A system and sigma-1 receptors involved in neuronal signalling. Meanwhile, ketamine interacts with another brain chemical called glutamate by blocking the NMDA receptors that this neurotransmitter usually binds with.
At a global level, psychedelic drugs have in common that they increase levels of entropy in the brain by allowing for communication between neural regions that don’t usually interact, and reducing the activity of a group of neural areas known collectively as the ‘default mode network’, which is involved in self-conscious thought. It’s believed that these neural changes lead to ‘ego dissolution’ and facilitate the mystical feelings of oneness and transcendence that are common to many trips.
The upsurge in research interest in psychedelic drugs and reports of their transcendent, life-changing effects have led to a steady flow of newspaper stories documenting their potential, and the publication of a spate of popular books about psychedelics. As curiosity about these drugs and their beneficial effects continues to grow, it raises the question of whether it’s possible for individuals to take these substances safely – and, if so, how?
Safety and legality issues
There are certain physical and mental health conditions that make it inadvisable to experiment with psychedelics, including heart problems and a history of psychosis or bipolar disorder. Antidepressant or antipsychotic medication could also interact unpredictably with the psychedelic. ‘Chronically, SSRIs [a form of antidepressant] may reduce the effect of psychedelics while other antidepressants may have other effects. But at this point there’s just not enough known about the effect of other psychoactive drugs on psychedelics,’ explains Sandeep Nayak, a psychiatrist at Johns Hopkins who has trained as a facilitator in psychedelic research studies.
‘If you have underlying mental health concerns or are experiencing depression, anxiety, or any medical issues, talk to a psychedelic-friendly therapist or doctor before taking substances,’ advises Sara Gael, director of harm reduction at the Multidisciplinary Association for Psychedelic Studies (MAPS) in the United States.
Even if you are fully fit and healthy, experts unanimously say that it’s a bad idea to take a psychedelic drug on your own, especially if it’s your first time. Ben Sessa is a psychiatrist, based in the United Kingdom, who has been researching the therapeutic effects of psychedelics for more than 15 years. He rejects the framing of the question in terms of whether it is possible to have a safe trip. ‘It’s like: “Is a knife safe or dangerous?”, it’s a ridiculous question. It’s about risk/benefit analysis.’ But he, like others, warns against journeying solo.
‘There are more risk factors [on your own] because there isn’t somebody there to manage your feelings or your behaviour,’ he says. ‘More importantly, you could be disorientated, and try to get in your car and drive away. Anything from the most benign behaviour – going online and buying 200 kg of avocados – to much more dangerous, there’s nobody who is not high who is able to temper your behaviour and make sure things are okay.’ Psychedelics have a profound effect on cognition, perception and coordination and you should take care to be in a physically safe, controlled environment. You should not plan to be driving, walking in traffic, be in high places or other dangerous environments which require you to be alert and coordinated.
Ideally you should identify an experienced and trusted guide or therapist to work with you before, during and after your psychedelic experience. Many cities in the US, Europe and elsewhere have psychedelics societies and these can be a good place to begin your search for a guide. At a minimum, make sure you are with a trusted and competent friend to keep you as safe as possible for the duration of the drug’s effects (consider, for instance, that the mind-altering effects of LSD can typically last up to 12 hours).
Another glaring practical issue is that, in most jurisdictions around the world, psychedelic drugs are illegal and if you are caught in possession, you will face criminal charges. This also has important implications for sourcing drugs safely. Françoise Bourzat, who has worked as a psychedelics guide in California for decades and is the author of the book Consciousness Medicine (2019), says that to source the drugs you will have little option other than to rely on word of mouth. ‘Always test your drugs,’ adds Gael. ‘Test kits are available on the DanceSafe website.’
If you decide to go ahead and it’s your first time, it’s sensible to start out with a weaker dose and, as mentioned, to pay due attention to the duration of the drug’s effects. The PsychonautWiki community encyclopaedia has information on dosing, duration and other practical issues.
However, even if you take these practical precautions, other experts urge an even more cautious stance. ‘I can’t and don’t endorse the use of psychedelics outside of research settings,’ says Nayak.
Fortunately, the physiological risks from the classic psychedelics are low to zero. ‘LSD and psilocybin are virtually inert physically – they have very low physical toxicity profiles so there are minimal physical risks,’ says Sessa. ‘They’re also not moreish,’ he explains. ‘You can see this in animal trials, they won’t repeatedly self-administer psychedelic drugs, they’ll take a single dose and then just largely ignore options to redose. So, the risk of addiction to psychedelics is low. Taking MDMA repeatedly long-term can be more harmful, but studies show that the physical risks go down after stopping.’
The main risks are psychological, and this is why preparation is so important. As safety guidelines for psychedelics trials from Johns Hopkins University put it: ‘The most likely risk associated with hallucinogen administration is commonly known as a “bad trip” and is characterised by anxiety, fear/panic, dysphoria, and/or paranoia.’
